title: Agenda setting in psychiatric consultations: an exploratory study.
abstract: OBJECTIVE
  Patient- or consumer-centeredness has been recognized as a critical component of quality in primary health care, but is only beginning to be recognized and studied in mental health. Among the first opportunities to be consumer-centered is collaboratively producing an agenda of topics to be covered during a clinic visit. Early agenda setting sets the stage for what is to come and can affect the course, direction, and quality of care. The purpose of this work is to study agenda setting practices among 8 prescribers (5 psychiatrists and 3 nurse practitioners) at the beginning of their encounters with 124 consumers diagnosed with schizophrenia spectrum disorders (56%), bipolar disorder (23%), major depression (15%), and other disorders (6%).
  
  
  METHODS
  We modified an extant agenda-setting rubric by adding behaviors identified by a multidisciplinary team who iteratively reviewed transcripts of the visit openings. Once overall consensus was achieved, two research assistants coded all of the transcripts. Twenty-five transcripts were scored by both raters to establish interrater reliability.
  
  
  RESULTS
  We identified 10 essential elements of agenda setting. Almost 10% of visits had no agenda set, and only 1 of 3 encounters had partial or complete elicitation of a single concern. Few additional concerns (4%) were solicited, and no encounter contained more than 6 essential elements.
  
  
  CONCLUSIONS
  Collaborative agenda setting represents a unique opportunity to translate the concept of consumer-centeredness into mental health care. Initial results suggest the rating system is reliable, but the essential elements are not being used in practice.
authors.affiliation: Department of Veterans Affairs Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Salyers
authors.forename: Kelsey A
authors.initials: KA
authors.lastname: Bonfils
authors.forename: Sylwia K
authors.initials: SK
authors.lastname: Oles
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009722:Nurse Practitioners; D009819:Office Visits / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods*; D011369:Professional-Patient Relations; D011570:Psychiatry / Q000379:methods*; D012017:Referral and Consultation; D015203:Reproducibility of Results